Strengthening the equity focus of applied public health research: introducing the FOR EQUITY platform.

OBJECTIVES: Much applied health research pays insufficient attention to potential unequal impacts across social groups or is typically focused on a single dimension (e.g. socio-economic status), rarely considering the intersecting social processes driving inequalities (e.g. racism, sexism, classism). All health research needs a strong intersectional equity focus in order to inform action to reduce health inequalities as well as improve population health. STUDY DESIGN: Focus On Research and Equity (FOR EQUITY) is a new Web-based platform aiming to strengthen the intersectional equity focus of applied health research. METHODS: The platform was developed in collaboration with members of the public, practitioners and researchers working internationally. The development involved a systematic review of academic and grey literature, a series of workshops and user testing. RESULTS: FOR EQUITY encompasses (1) a Health Inequalities Assessment Tool, with an intersectional perspective on inequalities; (2) a FOR EQUITY Guidance Inventory providing access to a range of international research toolkits and guidance; and (3) a FOR EQUITY Library including case studies illustrating how researchers have attempted to integrate an equity lens into the research process and more general resources on health inequalities. CONCLUSION: FOR EQUITY can support researchers to strengthen the equity lens in their studies to make research evidence more relevant for action to reduce social and health inequalities. However, a single focus on toolkits is unlikely to sufficiently address the barriers to embedding equity in research. A mainstreaming strategy to transform the very roots of the 'institution of research' is required.

An investigation of the attachment organization of clinical psychologists and its relationship to clinical practice.

Recent research on attachment theory as a model for understanding adult relationships and for psychotherapy suggests that the attachment organization of therapists could influence their approach to therapeutic work. A postal questionnaire including two measures of current adult attachment and one of early loss experience, together with measures of current clinical practice, was completed by 196 British clinical psychologists (40.4% return rate). Seventy per cent of the sample rated themselves as secure (a greater proportion than in the general population). The sample as a whole scored higher on the attachment pattern of 'compulsive care-giving' than on any of the other insecure patterns of attachment. A number of significant differences were found between the secure and insecure groups in approach to work, interest in working with different clients and difficulty experienced in therapeutic practice. A relationship was found between the amount of early loss experienced and current attachment style, therapeutic orientation and experience of therapy. Implications for the training and development of psychologists are considered and directions for future research are suggested.

Therapeutic commitment and role security in work with men with violence-related problems: an investigation and test of a model.

This study investigated whether therapists' therapeutic commitment and role security could be important therapist factors in therapy with those client groups that are perceived as being difficult to work with. Therapeutic commitment represents how committed therapists were to such work and role security measures to how secure they felt in their role. This study explored whether these factors could potentially explain some of the individual variation found between therapists in treatment outcomes. Following a pilot study, 209 therapists, consisting of 20 violence counsellors, 56 Relate counsellors, 58 forensic and prison psychologists and 75 clinical psychologists, completed self-report questionnaires by post about their work with violent men. Therapists' therapeutic commitment and role security were found to correlate significantly with expectations of clinical outcome on a case vignette, and with the level of violence that was usually worked with. Role security and therapeutic commitment also correlated significantly with therapists' level of experience, education about violence, role support and self-esteem. Differences existed between the professional groups on these latter factors and also in therapeutic commitment and role security. The results indicated the importance of role security in dealing with violence.

A comparison of two measures to assess adult attachment.

The purpose of this study was to determine the relationship between two different approaches to the assessment of adult attachment. The approaches were C. Hazan and P. R. Shaver's (1987) categorization of three attachment styles and the dimensional system of the Reciprocal Attachment Questionnaire (RAQ; M. West & A. Sheldon-Keller, 1992). Participants were 196 (72 men and 124 women) respondents to a community survey. Multiple regression results showed that the three attachment groups differed significantly on three dimensions of the RAQ: feared loss of the attachment figure, perceived availability of the attachment figure, and use of the attachment figure. In addition, men and women differed significantly on use of the attachment figure, independent of their attachment style. The results indicate that the two approaches to the assessment of adult attachment are interrelated in meaningful ways.

Quality assurance in mental health: the QUARTZ system.

This paper is concerned with how quality might be assured in mental health services. It includes an account of why a concern with quality and quality assurance procedures are now high on the agenda of the Health Service. A quality assurance programme requires a decision about what elements of a service to monitor, what information is relevant, how it can be collected, and a system for acting on the results. This paper provides a brief review of the kind of information that has been considered relevant and the methods that have been used to collect it. In addition, the principles underlying good and comprehensive quality assurance programmes will be outlined and the development of a particular system, known as QUARTZ, which has attempted to incorporate these principles, described briefly.

Evaluation in mental health services: some quality assurance models.

This paper examines the context in which a concern for evaluation in mental health services has emerged. Quality assurance activities are seen as the main method of evaluating such services at the present time. A distinction is made between internal and external approaches to quality assurance and an example of each method is examined for its strengths and weaknesses. Successful quality assurance programmes are seen as being dependent on an amalgamation of these two approaches and two generic systems which adopt this method, "QUARTZ" and "Psychiatric Monitor" are considered for their strengths and weaknesses. It is suggested that evaluation strategies should be assessed for their capacity to promote organizational change. The increasing influence of the User movement is discussed.

Creating an agenda for change. Quality assurance in mental health services.

Quality assurance is traditionally viewed in terms of structure, process and outcome, but ignores the fact that they coexist in day-to-day practice. Many quality assurance initiatives are based on the belief that organisational systems can be periodically improved using external experts; this can lead to a disjointed approach and alienate staff. QUARTZ is a quality assurance programme for mental health services, and encourages a collaborative, problem-solving approach among staff. Ongoing evaluation is essential to facilitate long-term change.